“Favour no particular outcome” – a guide for treating trans youth

GETA has published a how-to for mental health professionals on treating young people with gender identity problems.

The organisation GETA has produced a guide for clinicians on how to treat the rising number of young people looking for help with gender distress. Intended for those who work with children from puberty up to age 25, the guide promotes the “exploratory” approach, a process that helps the patient understand and untangle the roots of their suffering. This is in stark contrast to the affirmative model of health care, in which clinicians act as facilitators of their young patient’s gender transition.

Beyond WPATH

With this guide, GETA (the Gender Exploratory Therapy Association),  ‘a collective of psychotherapists, psychiatrists and psychologists, has produced the world’s first substantial analysis into appropriate clinical care for this vulnerable group of people. Until now, the only material available to clinicians was the WPATH (World Professional Association of Transgender Health) Standards of Care (version 8, known as SOC8 was published in September), political and ideology-driven documents that don’t meet the criteria for standards of care.

Rather than assuming that a young person suffering from gender identity problems is transgender, “A Clinical Guide for Therapists Working with Gender-Questioning Youth” proposes traditional psychotherapeutic methods.

“This is conventional psychotherapy that has been practised for many years,” says Stella O’Malley, one of the authors. “The gender affirmative approach is the new kid on the block. It is a new way to work with gender dysphoria, and has no long-term evidence base.”

“Gender affirmative clinicians have been winging it for the last decade, and now the outcomes are emerging and they are not positive. At GETA we use time-honoured conventional talk therapy to explore the conscious and the unconscious in an ethical and compassionate manner,” adds O’Malley, who worked on the guide with Sasha Ayad, Roberto D’Angelo, Dianna Kenny, Stephen B. Levine, and Lisa Marchiano.

A common developmental phase

Transition can involve any combination of social transition, drugs, and surgeries. But this means that children as young as nine are sometimes signing away their future sexual function or ability to have kids. This is far too young, say the authors. What’s more, being anxious or unsure about your gender identity is a developmental phase, and many young people who experience it turn out to be gay.

“In view of the heavy medical burden and risks associated with medical transition,” says the 127-page guide, “the uncertain long-term benefits, and low-quality evidence base, a growing number of public health authorities internationally are recognizing that less invasive approaches, such as exploratory psychotherapy, should be the first line treatment for youth with gender distress.”

The guide describes some of the milestones that have led to the adoption of the affirmative care mode, and refutes the low quality data upon which it is based. It also lists recommendations made by authorities in UK, Australia and New Zealand, Sweden and Finland, who have all recently taken a more precautionary approach to treating gender dysphoric young people.

Download A Clinical Guide for Therapists Working with Gender-Questioning Youth.